MEDICARE FRAUD: HHS LAUNCHES NEW PHASE OF ‘RESTORE TRUST’
"A federal government crackdown on Medicare fraud in fiveThis is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
states has been so successful that the Clinton administration is
expanding the pilot program to a dozen more states over the next
two years," USA TODAY reports. The program, "Operation Restore
Trust," has recovered more than $23 for every dollar spent, or
$187.5 million since 1995. The anti-fraud effort "targets
hospitals, nursing homes, home-health providers, medical-
equipment suppliers, and more recently, HMOs," USA TODAY reports.
The program, which has so far cost the government $7.9 million,
"aims to uncover fraudulent billing practices and overbilling in
Medicare and Medicaid." The program currently operates in
California, Florida, New York, Texas and Illinois. It is being
expanded to Arizona, Colorado, Georgia, Louisiana, Massachusetts,
Missouri, New Jersey, Ohio, Pennsylvania, Tennessee, Virginia and
Washington. The Clinton administration hopes to "[e]ventually"
include all 50 states in the program (Findlay, 5/21).
WHAT YOU SAY: Department of Health and Human Services
Secretary Donna Shalala said the program "has shown us how to
move faster and smarter in rooting out fraud and abuse in health
care. This is a model that works. Now it's time to take what
we've learned and use it broadly and aggressively" (HHS release,
5/20). While providers "generally support the crackdown," some
say the government has "labeled incorrectly innocent clerical and
accounting mistakes as fraud." Rick Wade of the American
Hospital Association said, "The Medicare program is filled with
arcane rules about how to fill out forms and file claims. They
are often not careful enough to distinguish between compliance
with the letter of the law and fraud" (USA TODAY, 5/21).